PB2249: SUCROSOMIAL IRON SUPPORT IN PATIENT WITH IRON DEFICIENCY ANEMIA IS HIGLY EFFECTIVE IN IMPROVING ANEMIA REDUCING ERYPTOSIS AND M1 MACROPHAGES POLARIZATION
Authors: G. giordano, M. napolitano, A. lucchesi
Journal: HemaSphere (2022)

Background: Sucrosomial iron is a macroassembly in wich a shield of polisaccarides protects a liposome that contains iron pyrophosphate. Sucrosomial iron allows a better iron absorbtion than iron sulphate, bypassing DMT1 and ferroportin. Iron support works improving effective erythopoiesis. It is due also to a reduction of eryptosis. A marker of eryposis is the expression of phosphatidyl serine(PS) on the external layer of erythrocyte membrane. Pro-inflammatory macrophages, increasing inflammations, impairs iron absorbtion and bioavailability. Aims: Aim of this study is to assess if sucrosomial iron support is effective in improving anemia and in reducing eryptosis by PS reduction on external erythrocyte membrane and M1 macrophages polarization. Methods: This study is a multicentric randomized1:1:1 study with informed consent. In group A100patients received sucrosomial iron containing phosphatidyl coline,in group B100patients received sucrosomial iron containing phophatidyl serine,in group C100patients received iron sulphate.In each group patients received 60mg of elemetal iron. Inclusion critheria were age>18years,no other causes of anemia,Hb<10g/dl, ferritin<30ng/ml,TSAT<20%, 1FOBT+/3 with EGDS and PCS normal,no neoplastic hypermenorrhea and/or menometrorrhagia,gastric bleeding(ulcer, gastritis, angiodysplasia),small intestine bleeding(angiodysplasia),Colon bleeding (diverticulitis, angiodysplasia, hemorroides). Exclusion critheria were:Loss of 1g Hb/dl in a time<7days,hyperthyroidism, Severe CHF,Autoimmune disease,IBD,ischemic/hemorragic enterocolitis,neoplasia with or without treatment,elmintic infestation, pregnancy/breastfeeding,severe organ failure,intolerance to iron sulphate. To measure PS expression we used a two-step flow cytometry procedure to quantitatively measure not only the externalPS but also the intracellular and shedPS. In this method,PS is first bound to fluorescent annexinV,and then the residual nonbound annexin is quantified by binding toPS exposed on apoptotic cells. M1 macrophages were counted by two tube cytoflurimetry(iNOS high /CD163 low/CD14+). Patients carachteristics were superimposable except for patients receiving sucrosomial iron in which start Hb level was lower (p<0.05). Hb median level in group Awas 8 g/dl,7.8 inB and 8.5 inC. Follow-up was6 months. Results: Median Hb concentration(g/dl) was at 4wks 9.5inA,8.6inB,8.8inC,at8wks 10.9inA,10.7inB,10inC,at 12wks 12.3inA,12.5inB,10.5inC. Median ferritin level(ng/ml) was at 0mo inA3,inB10,inC7;at3mo inA20,inB10,inC3;at6mo inA150,inB300,inC70. Expression of median %RBC with PS on external membrane was at 1wks 2.5inA,2.7inB,2.4inC,4wks 2inA,2.2inB,2.1inC,at8wks 0.8inA,1.1inB,1.5inC,at 12wks 0.7inA,0.8inB,1.6inC. Expression of median %M1 was at 1wks 1.5inA,1.2inB,1.3inC,4wks 1.1inA,1.3inB,1.2inC,at8wks 0.9inA,1inB,1inC,at 12wks 0.5inA,0.8inB,1.1inC. Summary/Conclusion: Sucrosomial iron formulation is more effective than iron sulphate in increasing Hb level in sideropenic patients increasing effective erythropoiesis and reducing eryptosis, by reducing expression of PS on the external membrane of RBC and reducing proinflammatory M1 macrophages.